84 Title 5 Application/Permits 1994, Inspections 1994, 2010 Owner
information is
required tor
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address: 84 North Farms Road
Owner' Name: Linda Warburton
City/Town: Northampton, MA 01060 Date of Inspection: 4/12/10
B. Certification (cont.)
Inspection Summary: Check A, B, C, D or E/always complete all of Section D
A. System Passes:
Y I have not found any information which indicates that any of the failure criteria as described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
N One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will
pass.
Answer yes, no, or not determined (Y, N, or ND) for the following statements. If"not determined", please explain.
N The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if
the existing septic tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
N Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval
by the Board of Health): broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
N The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
C. Further Evaluation is Required by the Board of Health:
N Conditions exist which require further evaluation by the Board of Health in order to determine if the system is
failing to protect the public health, safety or the environment:
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health, safety and the environment:
Cesspool or privy is within 50 feet of a surface water.
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
T5 Revised.doc•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 2 of 9
.r• ,� Commonwealth of Massachusetts
Title 5 Official Inspection Fc
Owner
information is
required for
every page.
II Subsurface Sewage Disposal System Form-Not for Voluntary Asses
Property Address: 84 North Farms Road
Owner' Name: Linda Warburton
City/Town: Northampton, MA 01060 Date of!napes on:
4/12/10
inspection results must oe suomlttea on um form inspection forms may not oe alterea in any way.
Owner Address: 84 N. Farms Rd. Florence MA 01062
Copy to: Board of Health Northampton _Denny Nolan Real Estate
Witness: Homestead Inc #- SSDS-1395
A. General Information
1. Inspector:
Name of Inspector: Thomas S. Leue R.S.
Company Name: Homestead Inc.
Company Address: 1664 Cape St , Williamsburg, MA 01096
Telephone Number: (4131 628-4533 License Number: SI130
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the information
reported below is true, accurate and complete as of the time of the inspection. The inspection was performed
based on my training and experience in the proper function and maintenance of on-site sewage disposal
systems. l am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR
15.000).The septic system condition must be evaluated and classified into one of the following four
conditions:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
The system condition: Passes
Inspector's Signature:
Date: 4/12/10
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of
Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a
design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the
appropriate regional office of the DEP. The original should be sent to the system owner and copies to the
buyer, if applicable, and the approving authority.
***"This report only describes conditions at the time of inspection and under the conditions of use at
that time.This inspection does not address how the system will perform in the future under the same
or different conditions of use.
T5 Revised.doc•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 1 of 9
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address: 84 North Farms Road
Owner' Name: Linda Warburton
City/Town: Northampton, MA 01060 Date of Inspection: 4/12/10
B. Certification (cont.)
E] Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 to
15,000 gpd. For large systems, you must indicate either YES (Y)or NO (N) as to each of the following, in addition to
the questions in Section D.
N the system is within 400 feet of a surface drinking water supply
N the system is within 200 feet of a tributary to a surface drinking water supply
N the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a
mapped Zone II of a public water supply well
If you answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes' in
Section D above the large system has failed. The owner or operator of any large system considered a significant
threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The
system owner should contact the appropriate regional office of the Department
C. Checklist
Check if the following have been done. You must indicate YES(Y)or NO ON as to each of the following:
Y Pumping information was provided by the owner, occupant or Board of Health._
N Were any of the system components pumped out in the previous two weeks? _
Y Has the system received normal flows in the previous two week period? __
N Have large volumes of water been introduced to the system recently or as part of the inspection? _
N/A Were"as-built" plans of the system obtained and examined? (If not available note as N/A) _
Y Was the facility or dwelling was inspected for signs of sewage back up? __
Y Was the site was inspected for signs of break out? _
Y Were all system components, excluding the SAS, located on site? _
Y Were the septic tank manholes uncovered, opened, and the interior of the septic tank inspected for the
condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and
scum?
Y Was the facility owner(and occupants if different from owner) provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Y Existing information. For example, a plan at the Board of Health.
N Determined in the field Of any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CMR15.302(5)].
T5 Revised.doc•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 4 of 9
•/ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Owner
information is
required for
every page.
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address: 84 North Farms Road
Owner' Name: Linda Warburton
City/Town: Northampton, MA 01060 Date of Inspection: 4/12/10
B. Certification (cont.)
2) System will fail unless Board of Health (and Public Water Supplier, if any)determines that the system
is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface
water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private
water supply well" Method used to determine distance
•*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria
indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided
that no other failure criteria are triggered.A copy of the analysis must be attached to this form.
3) Other:
D. System Failure Criteria Applicable to All Systems:
You must indicate either YES(Y)or NO(N) as to each of the following for all inspections:
N Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
N Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
N Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
N Liquid depth in cesspool is less than 6" below invert or available volume less than 1/2 day flow.
N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of
times pumped
N Any portion of the SAS, cesspool or privy is below high ground water elevation.
N Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water
supply.
N Any portion of cesspool privy is within a Zone I of a public well.
N Any portion of cesspool or privy is within 50 feet of a private water supply well.
N Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply
with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a
DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are
triggered.A copy of the analysis must be attached to this form.]
N The system is a cesspool serving a facility with a design flow of 2000 gpd-10,000 gpd.
N The system fails: I have determined that one or more of the above failure criteria exist as defined in 310 CM
15.303, therefore the system fails. The system owner should contact the Board of Health should be contacted
to determine what will be necessary to correct the failure.
COMMENT:
T5 Revised.don•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 3 of 9
Owner
information Is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address:
Owner Name:
City/Town:
84 North Farms Road
Linda Warburton
Northampton MA 01060 Date of Inspection: 4/12/10
D. System Information (cont.)
Approximate Age: All components, date installed (if known)and source of information:
Septic plan:
N
dated 6/1/97
Were sewage odors detected when arriving at the site(Y or N)
Building Sewer: (locate on site plan)
32 Depth below grade (inches)
_ PV C plastic Material of Construction _
26 Distance in feet from private water supply well or suction line
Comments: No problems seen.
Estimated Average
[Septic Tank:
32
Concrete
24
58
126
56
1,776
8
1,500
26
4
26
1
17
6
(locate on site plan)
Depth below grade (inches)
Materials of Construction
If tank is metal, list age
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate)
Riser depth
Septic tank width
Septic tank length
Septic tank height
Calculated gross volume
Air space in tank
Net Volume
Baffle depth
Sludge thickness
Top Sludge : Bottom Baffle
Scum thickness
Bottom Scum : Bottom Baffle
Top Scum : Top Baffle
(inches)
(inches)
(inches)
(inches)
(gallons)
(inches)
(gallons)
(inches)
(inches)
(inches)
(inches)
(inches)
(inches)
Interior dimensions
Interior dimensions
Interior dimensions
Calculated
Calculated
Average
Calculated
A‘aage
Calculated
Calculated
Measured How were dimensions determined?
Comments:
No operational or structural problems seen. Front tank.
Pump within next 3 years. Tees intact. Water level appropriate.
Risers over inlet and outlet.
Rear tank same size, but 10" below grade, no risers.
Rear tank has minimal solids, less than 3" total, and does not need
pumping ani time soon.
15 Revised doe•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 6 of 9
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address: 84 North Farms Road
Owner'Name: Linda Warburton
City/Town: Northampton, MA 01060 Date of Inspection: 4/12/10
D. System Information
Residential Flow Conditions:
3
▪ 3
499.5
J
Number of bedrooms (design)
Number of bedrooms (actual)
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#bedrooms)
2 Number of current residents _
Y Does residence have a garbage grinder? _
N Is the Laundry a separate system? [If yes, separate inspection required]
N Laundry system inspected?
Seasonal use?
N/A Water meter readings, if available (last 2 years usage (gpd))_
N Sump Pump? _
continuous Last date of occupancy
Type of establishment:_
Design flow (based on 310 CMR 15.203): = gpd
Basis of design flow(seats/persons/sift, etc.): _
Grease trap present? _
Industrial waste holding tank present 9 _
Non-sanitary waste discharge to the Title 5 system? _
Water meter readings, if available: _
Last date of occupancy/use: _
OTHER (describe). _
General Information
Pumping Records: Source of information:Svner says pumped 2004
Was system pumped as part of the inspection (Y or N)
If yes, volume pumped: gallons
How was quantity pumped determined?_
Reason for pumping:
Comment: Pump on 3 to 4 year interval.
Type of System:
X Septic tank, distribution box, soil adsorption system
Single cesspool
Overflow cesspool
Privy
• Shared system (Y or N) Of yes attach previous inspection records, if any) =
Innovative/Alternative technology. Attach copy of the current operation and maintenance contract(to be
obtained from system owner) =
Tight tank(Attach a copy of the DEP approval) =
Other(describe): =
T5 Revised.doc•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 5 of 9
Commonwealth of Massachusetts
9 Title 5 Official Inspection Form
r�l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address: 84 North Farms Road
Owner Owner Name: Linda Warburton
information Is
required for City/Town: Northampton, MA 01060 Date of Inspection: 4/12/10
every page.
D. System Information (cont.)
Distribution Box: Of present must be opened) (locate on site plan) ("D-box")
Y D-box part of septic system?
0 Depth of liquid level above outlet invert Tnche,
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, and
:out of D-box, etc.): 3 pipes out. No biosolids in box. Structurally intact.
'Pump Chamber: (locate on site plan)
Y Pump part of septic system?
Y Pumps in working order: (Y or N)
Y Alarms in working order: (Y or N)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
,Large riser to surface. Looks OK. Alarm panel on house exterior.
'Cesspools: (cesspool must be pumped as part of inspection) (locate on site plan)
N Cesspool part of system?
Number and configuration:
Depth-top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow
Comments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Privy: (locate on site plan)
N Privy part of system?
Materials of construction:
Dimensions:
Depth of solids.
Comments: (soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Site Exam: (Source of Information)
Y Check Slope 5/9/97 Official Perc Date
Surface water 6/1/97 Official Plan Date
Y Check Cellar Other Official Source
N Shallow wells Other Source
60 Estimated depth to ground water (inches)
Please indicate all the methods used to determine high groundwater elevation:
Y Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-explain:
You must describe how you established the high ground water elevation:
,Depth determined during perc test. Site built up to be
out of water table.
T5 Revised doc•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 8 of 9
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address: $4 North Farms Road
Owner' Name: Linda Warburton
City/Town: Northampton, MA 01060 Date of Inspection: 4/12/10
D. System Information (cent.)
Grease Trap (Usually present in certain commercial systems)
N Grease Trap pan of system?
Depth below grade (inches) Measured
Materials of construction:
Dimensions:
Scum thickness (inches) Average
Top of scum to top of outlet tee alculated Inches
Bottom of scum to bottom of outlet tee Calculated Inches
Date of last pumping
Comments: (on pumping recommendation, inlet and outlet tee or baffle condition,etc.)
Tight or Holding Tank (tank must be pumped at time of inspection)
N Tight tank part of system?
Depth below grade (inches) Measured
Materials of construction
Tank width Tank length (inches)
Tank height Capacity (gallons)
Design flow: gallons/day
Alarm Level (inches)
Alarms in working order?
Date of last pumping
Comments: (condition of alarm and float switches, etc)
Attach copy of current pumping contract(required). Is copy attached?
Soil Absorption System(SAS):
f SAS not located
xplain why:
(locate on site plan, excavation not required):
leaching pits& number
leaching chambers and number:
leaching galleries and number:
Y leaching trenches, number, length: 3 trenches each 36 ' long
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative system, Type.
Comments: (note soil condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
I System vent included.
No surface problems seen.
T5 Revised.doc•09/09 Title 5 Official Inspection Form:Subsurface Disposal System•Page 7 of 9
o Sewer connections approximated. l r
Tank 2 . Vent
NORTH !
‘1 jl town water in !,
A I
B.
D-box_ .. I
Alarm Panel -�-Il-
--- -_-- House Outline �
I
! Leaching trenches, approximate layout.
D C
-
I I --__-- - - Pump tank _ -
Tank 1 ❑ ❑ ❑/ [Item Location "A'
!Tank 1 Inlet !.` 20 1/2 ft. 18 ft.
!Tank 1 Outlet 15 ft. 24 1/2 ft.
Tank 2 Inlet 40 ft. 29 ft.
Tank 2 Outlet 48 ft. 30 1/2 ft. _
Pum. Tank Cover Center 47 1/4 ft. 22 ft.l
.D-Box Cover Center 75 ft. 81 ft.!
(Vent Site 107 ft. I
Note: No known drinking water sources within 100 loot radius.
COMMENTS:
Recommend pumping on a 3 to 5 year schedule. Also, a copy of this plan posted in the
basement/utility area would keep this information accessible in future years for maintenance.
Date: Owner: tP of ��
As-Built Drawing 4/12/2010 Linda Warburton oee y' HOMESTEAD INC.
Existing Septic System I_e TMppA48, Thomas S. Leue R.S.
84 North Farms Ro- LEUE�
Scale: 1 : 20' Revision Date: / �,�.. 72 r 1664 Cape St.
Except as Noted Florence, MA 01062 9t�hhREO Po-''Qe_
Williamsburg,
[413] 6] n96
6-533
Location Address or Lot No
M&a-Wf /gams 12,
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
A On-site Review
Deep Hole Number A Date:S _1.f Time: 9.so Weather 2f24-)
Location (identify on site plan)
Land Use 2 5 7c Z..q(_. Slope 1%1 /0 Surface Stones Yo
-c
it751Q
Landform Raget ev7W 444
Position on landscape (sketch on the back)
Distances from:
Open Water Body //f. feet Drainage way /µcue feet
Possible Wet Area /OD feet Property Line feet Tea He U'.E.
Drinking Water Well reu.A/ feet Other
DEEP OBSERVATION HOLE LOG'
Depth from
Surface(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
IMunsell)
Soil
Mottling
47
II
C
G/ /s
15-
`/S
Io y'342
h /I
Other
(Structure.Stones, Boulders. Consistency, %
Gravel)
..+C-`12
c tecmft/Jc
0-r EL
xS/
1-7 NC Lonniy
✓/ 79ii/ °T
Uczy
[_rose
!Y la ate+ -CLI> 34l wy fiIt9/2'
Parent Material (geologic) J L T to- 9 t
MINIMUM OF 2 HOLE b HEUUIREU AT EVEHV PHUPUSEU DISPOSAL AREA
/1
DepthtoBetlrock: i/-�
aL
Depth to Groundwater: Standing Water in the Hole: q Weeping from Pit Face: CC��
9 G n 6,-c TG jL"2r+.-f'
Estimated Seasonal High Ground Water: (O/% " c:,A' L.'CCk..� q //d-At .5r
'9 Afi. 13 .25-77 /{/yA Cgs-pi 9 M/% 77-7;,ei
DEP APPROVED FORM-12107/95
No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: _5----
j 7
Commonwealth of Massachusetts
to rnr� , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: _.-DENMl-> 2. L,9-cdV'ZS�
Witnessed By: 1;.-c7'c2. ✓2= t2 /9i..v
Date:.? -� • 7
mno Amy or
Lot 0
New Construction ❑ Repair Ll'
u.R,I wm, m e ..,+ ®,,Y at c4- ✓flc GBY
'en." 63 l++e frIt FA. q 02.42
ni.vma I
. Nrt -tt ..prmw °021Y.
Office Review �c�I
Published Soil Survey Available: No ❑ Yes IrF
Year Published 1A/'1 1J Publication Scale I J. LO Soil Map Unit /3
Drainage Class WKLD1.4w F7 Soil Limitations S r+Pt ,First (exc.,
Surficial Geologic Report Available: No 2 Yes ❑
Year Published .. Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No 0Yes 71
Within 500 year flood boundary No Z x es ❑
Within 100 year flood boundary No ig Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month
Range :Above Normal Biormal Below Normal ❑
Other References Reviewed:
DEP APPROVED FORM-11/07/95
Location Address or Lot No. (7.tj
FORM 11 - SOIL EVALUATOR FORM
Page 2 or 3
,UaAfl r4-R 02) a7-,Q
On-site Review
Deep Hole Number C _ Date:0/17
Location lidentify on site plan)
Land Use QCS(>,te N)1'9t Slope (%) /z
Vegetation ./!^i&
Landform .IC/ ?
Position on landscape (sketch on the back) -
Distances from:
Open Water Body, /..5 S feet
Possible Wet Area- feet
Drinking Water Well 72"a 4j feet
Time/4-'1
Weather /fF/-b_..
Surface Stones }(r _S
Drainage way brvart feet
Property Line __ feet
Other
DEEP OBSERVATION HOLE LOG
Depth from Sod Horizon Soil Texture
Surface(Inches) (USDA)
Soil Color
IMunselll
Soil
Mottling
(MUM ur 1 nULCS Rt(UI
Other
(Structure.Stones. Boulders, Consistency, %
Gravel)
Ait& 49-ct9Ancic
e i/
tril
,L;tee 5(LT-
SArts
•j7/
U AI tVtriY PHOrrUScU UISr'USAL AREA
Parent Material(geologic) pt JvAh 4
Dean to Groundwater Standing Water in the Hole:
Estimated Seasonal High Ground Water:' 791 ft
Depthro Bedrock:
/V°A't= Weeping from Pit Face: 2'a !i
DEP APPROVED FORN•12:07/95
Location Address or Lot i'to
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
C'y f'&ns
On-site Review
Deep Hole Number e _. Date:5/th> Time:7#OLg'9 Weather /z9/4) _...
Location (identify on site plan)
Land Use 225i ,1727-,fL o>:-_ :, !D Surface Stones 5
Vegetation
Landform 2.1r7-4-1^V7 .. ..
Position on landscape (sketch on the back)
Distances from:
Open Water Body, feet Drainage way N wr feet
Possible Wet Area JD0 feet Property Line feet %* 4pL 5
Drinking Water Well iP0‘)91 feet Other
DEEP OBSERVATION HOLE L OG'
Depth from
Surface Ilnchesl
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure,Stones, Boulders, Consistency, %
Gravel)
C 'Fo 6"
I
I'D 44)
Le ti, (a0
4
/;r/
C
SIr_
-
�S
lay Pi .
-
�eyQ�
3
_
— //
–
%d'vL
.95 Off
m .9Nf c
h 'ff Gse •, S.tN7
vfc�-y Lov> • akrP- si✓S
' MINIMUM UY C HUL�LpO nGUGlntL)A/I [Venr rnuvuou
parent Material (geologic) V Iyf c--t 5 _//''O
Depth to Groundwater: Standing Water in the Hole: TCi"
Estimated Seasonal High Ground Water:' 6‘)4
DEP APPROVED FORM.-12:07195
//
Oepthto8edrock: ��
Weeping from Pit Face. Jr:(IV;_.> 4.2.422-)2
St'„ yte-.9.,09. ,9-L
FORM 12 - PERCOLATION TEST
Location Address or Lot No. p ,a-p not sty R-a
COMMONWEALTH OF MASSACHUSETTS
»o-2779 ,t' , Massachusetts
Percolation Test'
Date: ' - T-t 7 Time:, V, .1
Observation Hole #
^
Arsa
Covi er72-c
Depth of Perc
22) (/
r 7- AAD>- Do NE.
Start Pre-soak
q. (J
rjvc 7-) Jo?3r a.,7
End Pre-soak
(D: b
� E 4oi c
5'' s - /fit
�a4 Dn.tribtovS
/-5-4. N. .y�� t
474 reD n- s.-9mc
Time at 12"
ID.' vo
Time at 9"
11 • o4
Time at 6"
/ 1) .' /G
Time (9"-6")
/D
Rate Min./Inch
"
' Minimum of 1 pe colation test must be performed in both the primary area AND
reserve area.
Site Passed Site Failed ❑
Performed By: ! �tn'A)i d2 q r -vc Ye-
Witnessed By: ! /rlc &21-41/AJ
Comments:
DEP APPROVED FORM-I2/07/95
FORM 11 - SOIL EVALUATOR FORK
Page 3 of 3
Location Address or Lot No. ?y itJe-el-H Fe.ny 2Pr
Determination for Seasonal High Water Table
Method Used:
u
Depth observed standing in observation hole /e0
g Dept from slue of observation hole ..
Depth to sod motnes t,L inenes
J Ground water adjustment feet
Index Well Number Reading Date
inches
inches
Index well level
Adjustment factor Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring
observed throughout the area proposed for the
If not, what is the depth of naturally occurring
Certification
pervious material exist in all areas
soil absorption system? yr=
pervious material?
I certify that on // t r (date) I have passed the soil evaluator examination
approved by the De artment of Environmental Protection and that the above analysis
was performed by me consistent with t - req ' -d training, expertise and experience
described in 310 CMR 15
..
e
Signatur= ///r�.lIlir % Date,5 —7.17
DEP APPROVED FORV- 12.07,95
.g�� 4 44?/171 j pl_t/Q (`(
(71 Amy •2
b
a
L
/,aM 3n iaa
7HO O
4
7:4/
H O 1-10 fl 1}o
Jtno ?_)
d
anocr
S Cn 1?-ni
�) J'9S ° l j oc'l
.67d 4‹v&°l!. , pe zC2 776111
t4T� TM�L , QI rr3A1 H349 °9 W 150 11 cu l4 As
FORA f 71 - SO!L EVALUATOR FOR\f
Page 2
On-site Review
Deep Hole Number IL... Dater/P/57 Time://250 Weather /2/1V1./
Location (identify on site plan) _.
Land Use 6 ! ;/>A ''7L Slope (927)/0 -. Surface Stones S .3
Vegetation rrch9 _.
Landform A/P62aje> 6!l%WA 5_
Position on landscape (sketch n ::e bon.
D i:fiances from:
Open Water Boo? fett Uralnage way MO)C feet
Possible Wet Area /DP. feet Property Line _ feet (?27'use
Drinking Water Wel' 72744) feet Other _...
EP OBSERVATION-IDLE' LOG
Depth !torn Surface Sall Hcr.zo
ll•'chesl
4•� -s SLR
7 Y. iC I At)
Sall Texture Soil Color
IUSDAI IMunsei9
Flt
C
4/u.
qLL ft/f iv
Sall Mottling
Other
(Structure, Stones. Boulders,
Consistency. % Grovel(
27e.„3fa
No
fi//
O34 Eau cr.
RT Ca0 is
2r nte✓c 2
�/a. ;V e
Jay C.wsc
f z'r f.,424,
/Yl4h9/riE
Parent Material (gejlogicl n77/vAe S
Deszt. Ta Grcunc.varer
atrna:ed S
t4
Depth to Bedrock: 1?D
/I 4'
Ip t .� Vies-pH: 4-7.-7! pit Face: �O
oea bur Grounc Water: ZD
TIMOTHY E. MAGINNIS, RS
Environmental Consultant• Registered Sanitarian
70 Montague Road
Westhampton, MA 01027
(413) 527-5291
Northampton Board of Health
City Hall - Main Street
Northampton, Ma 01060
Attn: Mr. Peter McErlain
Health Agent
Re: Northampton - FINAL INSPECTION
84 North Farms Rd.
Sept. 17, 1997
Dear Mr. McErlain:
This letter is to inform you that the individual subsurface
sewage disposal system which is owned and operated by Mr. Patrick
McCoy of 84 North Farms Road in Northampton, Ma. has been
installed in accordance with the State Sanitary Code Title-V.
The system was installed by Hatfield Equipment of Hatfield, MA.
in September, 1997.
with diligent maintenance and operation it should provide trouble
free service in the years to come.
If you have any questions please do not hesitate to contact me.
Very truly yours;
_ r
1 0J c ! C Y�) ,1-2 A ,
Timothy rp.- Maginnis RS
c .c. Mr. Patrick McCoy
84 North Farms Road
Northampton, MA 01060
1500 GALLON SEPTIC TANK
BUOYANCY CALCULATIONS
WEIGHT OF 1500 GALLON TANK
1500 gallon septic tank (10 '1 x 5.66'w x 5. 33'h)
Sidess (10' 1 x 5 .33 'h)2 sides = 106.6 sq.ft. x .25 'thick
= 26.6 cu.ft.
Top/bottom: (10 ' 1 x 5 .66'w)2 = 113 .2 sq.ft. x .333 'thick
= 37.70 cu. ft.
Ends: (5 . 66'w x 5 .33 'h)2 ends = 60 .33 sq.ft . X .25 'thick
= 15 .10 cu.ft .
So: 26.6 cu.ft + 37.70 cu.ft. + 15 .10 cu.ft . = 79 .40 cu.ft.
Then: 79 .40 cu.ft . x 1501bs/cu.ft (CEMENT) = 11910 lbs .= WT(tank)
VOLUME OF TANK = 301 .676 CU. FT.
310.678 CU. FT. x 62 .43 lbs/cu.ft. (WT. OF WATER) = 18833 .75 lbs.
Therefore: counter weights or straps needed to secure proposed
1500 gallon septic tank.
PUMP CHAMBER
BUOYANCY CALCULATIONS
WEIGHT OF 1000 GALLON PUMP CHAMBER
1000 gallon septic tank (8 .5 ' 1 x 4 .83 'w x 5 .33 'h)
Sides: (8.5' 1 x 5.33 'h)2 = 90.61 sq.ft. x .25 'thick
= 22 .65 cu.ft.
Top/bottom: (8.5 ' 1 x 4 .83 'w)2 = 82 .11 sq.ft. x .333 'thick
= 27.34 cu. ft.
Ends: (4 . 83 'w x 5 .33 'h)2 = 51 .49 sq.ft. X .25 'thick
= 12 .87 cu.ft.
So: 22 .65 cu.ft + 27.34 cu.ft. + 12 .87 cu.ft. = 62 .86 cu.ft.
Then: 62 .86 cu.ft. x 1501bs/cu.ft (CEMENT) = 9,429 lbs.= WT(tank)
VOLUME OF TANK = (8 'L x 4.33'W x 5 .83 '11) = 167.31 CU. FT.
167 .31 CU. FT. x 62 .43 lbs/cu.ft . = 10,445.16 lbs.
Then: 10,445 .16 lbs (-) 9 ,429 lbs = 1016.16 lbs
Therefore: minimum of 1016.16 lbs of counter weights or straps
needed to secure proposed pump chamber.
No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: 5 j
Commonwealth of Massachusetts
, Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: ...DE.,iAy 2. c- Date:S —� • I.2
Witnessed By: ..., '2 to2 c e /e,.,v
Locuron Address or
La
New Construction ❑ Repair 1*
Cartes Hurt. me F (nas P,17 tc&- ✓97,ceV
.�"b C6 me ti ( 02.i2
Te.om-,
Office Review
Published Soil Survey Available: No ❑ Yes ‘g
Year Published U./Ii81_. Publication Scale / �S Lip Soil Map Unit /3
Drainage Class WaLDx41N=7 Soil Limitations 5ceG? r Pt,r Pray
Surficial Geologic Report Available: No Yes ❑
Year Published
Geologic Material (Map Unit)
Landfonn
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes
1y "
Within 500 year flood boundary No 'Thies es ❑
Within 100 year flood boundary No 'ig Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Publication Scale
Current Water Resource Conditions (USGS): Month
Range Above Normal Pdlormal El Below Normal ❑
Other References Reviewed:
DEP APPROVED FORM- 1:107195
Location Address or Lot No. 2.9 k16,221-if l3 n' ' 2g
FORM II - SOIL EVALUATOR FORM
Page 2 of'3
A On-site Review
Deep Hole Number A Date:% _5.i-2 lime:.`/ 3o
Location (identify on site plan)
Land Use $ 54-D=T..OL Slope (Vol /5
Vegetation t/&-)B
Landform R.Le?.3ci7....ev7e4r ASS _
Position on landscape (sketch on the back)
Distances from:
Open Water Body //6 feet Drainage way No-wt feet
Possible Wet Area let feet Property Line
Drinking Water Well ro.r.At feet Other
Surface Stones Yc
Weather 2A'GJ
_ - feet Te HcusC'
DEEP OBSERVATION HOLE LOG*
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (Inches)
(USDA)
(Munsell)
Mottling
(Structure,Stones, Boulders, Consistency, %
Gravel/
0 Te $e
A
S/L
iG l(.t'6
I'lel
m.../.1. Ado it.'
/4;4 5.
To bo/'
l it
nt )
F;II
car.aslny
/
FGi
v
(et, 4,0
6cya ! c'
`/5
1ey•2. '/L3
5rola
ton: Lvsitny ,,71✓-P
LL !y
��
✓L td ,
C ,6
>i 6`/JC>
IV. '7/ l/2"� !/orgy Loos
Tz
1.
L `
�7 / L%//X
Sztt•ie
A-7"---
-, CG
4- Y 5,
L7 Am -OLD 4„.,l6 ) , 77&j
Parent Material (geologic) 0 cT co-9.4 ti
I-1)
Dep htoBedrock: /30
4L
Depth to Groundwater Standing Water in the Hole: 1J0/' Weeping from Pit Face: S hoc 7
Estimated Seasonal High Ground Water: (U%J r/ :3/ir•L w Li Ill LrJ'ccP %
J A' U 3 'ant_✓c n //, 4 n¢tor 9
DEP APPROVED FORM-12/O7/95
swv�j u -'ec
d
ti
A rf 3n ia�7 P
e A !,
7H0 HO i tj14 0
? tno ?-1
/ G
d
rr,gd
irt
oat
•ps 4,4 ver'not , per -vC 77NI//
q(17a-o l ) Q/ rrant yl4Q 0 9 77A, .2561'7( 14044 As
•
Etifc1 It - SOIL EVALUATOR FOr■I
Page 2
On-site Review
Deep Hole Number I/ Dater/07 Time://APO Weather
Location (identify on site plan}
Land Use ?=S11,=`At4 t- Slope (%)/LP Surface Stones -
Vegetation f-rc%Q
Landform &/. Cre e D 4FLJ74)8 5
Position on landscane (skein: on tiro bard -
:istancts from:
Open Water Body _.._. ieer. Ural.tcge way Noree reef
Possible Wat Area /BD feet Property Line _ __ feet (fouae
Drinking Water Wel' 7 k4 Other
DEBT OBSLRVATIO hIOLE LOG
Deotn from Surface
Iln.nesl
So' hicrizao
Soil Texture
(USDA}
Soil Color
IMunseol
Soil Mottling
Other
(Structure, Stones. Boulders
Con siste::cv. % Graven
o
SLL tb- (Ab
A I
1/ ice/ /2
C
L,/5
/-1
N0 (y�L/.9.tll t
ri/
G35C-4✓ci
,pT Co.;'
+ey LOP-sc
/Mg syi9
Parent Material (geklogic) _O7wA5
Oeot'n to Ground'waiat:
rt P
Depth to Bedrock: 1>D
/1
it the Heie: 7 Weeping from Pit Face: Co°
_,.root=_e ;e.asonai h:gs Grocnd Water: jc0 P
Location Address or Lot No.
FORM 11 - SOIL EVALUATOR FORA
Page 2 or 3
cgLI N6/2-7/9 YLi44,4)6 ,Q;
On-site Review
Deep Hole Number _ Date:37th, Time:/#2,brPO Weather /09/4.) _.
Location (identify on site plan)
Land Use - [42 i t^?T4L Slope l%1 l6 Surface Stones j! ->..
Vegetation (Y.=1�
Landform L?.lvas.3e_0_Pct.-r4-.^✓i
_ --facade (sketch on the back)
Distances from:
Open Water Body, /: o i feet Drainage way N<i,r feet
Possible Wet Area./BO feet Property Line feet tv jhr° 'C
Drinking Water Well ice''^/ feet Other
DEEP OBSERVATION HOLE LOG'
Depth from
Surface (Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure.Stones.Soulders. Consistency, %
Graven
O % �/,
t0 igo
6e tD ( 0
)
/7//
C
54L
—
/
IOy ,4 .
Jbya/
3
d ..9,--Yc
777(
}
h Gde S.r ��
//CC LPfl PO-i nff/�
�mi
g9 O(t/
4
HDLES dE(lU1ftc0 A f E V E
Parent Material)geologic) lJ 0-1-01.4' 4
Cc U UpfUDALAMCA
Depth to Groundwater: Standing Water in the Hole: i 2./r
Estimated Seasonal High Ground Water:- /‘34
Depthm Bedrock:
Weeping from Pit Faceu6Z . 3ix�pi,= 44— -52
4 "' ',a c-9 Dt.r5 'i t
DEP APPROVED FORM 1::07/9
Location Address or Lot I' o
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
On-site Review
Deep Hole Number C _ Date:0/ii? Time/x.36 Weather R?/'t"__
Location (identify on site plan) _
Land Use 4 C}(D /OWL Slope (%) /e5 Surface Stones ,Sfa...S.
Vegetation
Landfarm
Position on landscape (sketch on the back) . .._..
Distances from: •
J
Open Water Body. /.51S/`S feet Drainage way Amf feet
Possible Wet Area• /">c feet Property Line feet
Drinking Water Well 7a"-✓ feet Other
-� -(.UIHeJ.a c`/cdV rrxI r'ilacJ UL rUSAL AMC. •
Parent Material lg. logic) ,d bT iv"%'>
Depthta Bedrock:
Deoth to Groundwa er: Standing Water in the He le:
Estimated Seasonal High Ground Water:' %. ri
Ataitt-
x /7
Weeping from Pit Pace: ,%si ��
DEP APPROVED FORM•lt07/95
DEEP OBSERVATION HOLE LOG'
Depth from
Surface/Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
IMunsell)
Soil
Mottling
Other
/Structure.Stores,Boulders, Consistency, %
Gravel)
z -fz
7e T. 7,z
7� T w
f=, 0
6,
Sl/L
•
/7//
`l l Li
/c_
t7%
a.>rT
Z(,
3//s6
/ /
Y
/%-2/
,f4 3
Ha/c 1!3^
I%4r'jc LbL
/7 it
f•^t= SrLY
I 1-57-4-,6 59-4>y �.$
5C
+ l.iIAUAAiiA1 !L l . d. t
-� -(.UIHeJ.a c`/cdV rrxI r'ilacJ UL rUSAL AMC. •
Parent Material lg. logic) ,d bT iv"%'>
Depthta Bedrock:
Deoth to Groundwa er: Standing Water in the He le:
Estimated Seasonal High Ground Water:' %. ri
Ataitt-
x /7
Weeping from Pit Pace: ,%si ��
DEP APPROVED FORM•lt07/95
FORM 12 - PERCOLATION TEST
Location Address or Lot No. t,+aa-tr ? cn.ro- ,Za G07-
COMMONWEALTH OF MASSACHUSETTS
1^ib--zZ-Hs«p3 , Massachusetts
Percolation Test'
Date: S g'17 Time:, V hjO_..
Observation Hole ,!
^L
G
Depth of Perc
22) 11
7-.45. -- JJro9- Pt.A7C
Start Pre-soak
p ���
rni- 7 ycSr .5.4.)P
End Pre-soakj.4✓'E
It: DO
2oiLS _ f//e
/ 2q Pow,c26V$
Time at 12"
1D.' DD
f3.o. P. r�T
py2ecD r- S.4nt
Time at 9"
lU � 040
Time at 6"
Time (9 -6 )
/D
Rate Min./Inch
y
' Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed
Site Failed ❑
Performed By: ivy!, (2_,
vc Ye-
Witnessed By: /�� 1lz‘. a'22-4YAv
Comments:
DEP APPROVED FORM-I2/0I/95
FORM 11 - SOIL EVALUATOR FORM
Page 3 or 3
Location Address or Lot No. 89 r t)e d-f i F 5 Zia
Determination for Seasonal High Water Table
Method Used:
u
‘Vi—Depth observed standing in observation hole 20 O inches
E Depth weeping from side of observation hole .. &.L inches
tai c�
Depth to soil mottles GD inches
Ground water adjustment feet
Index Well Number _ . Reading Date Index well level
Adjustment factor Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring
observed throughout the area proposed for the
If not, what is the depth of naturally occurring
Certification
pervious material exist in ail areas
soil absorption system? yr=S
pervious material?
I certify that on // 95-— (date) I have passed the soil evaluator examination
approved by the De artment of Environmental Protection and that the above analysis
was performed by me consistent with t req :�-d training, expertise and experience
described in 310 CMR Ai y . ,,
I/Signatur iii..%am..✓.,„% Date -7r77
DEP APPROVED FORM- 1`/07195
. . _.__ _._.._ .—_. FOiat'n retcounon TEST
lwatien
. . . EALTN OP-14fASSACH03ET'fs _
Massachusetts
® -
laiii11111111111111—
inn:atti�-
Tiny at 9' 11.111111111.1.11111
IDvat 6'
Rau minznch
pieAiiin baa ttaut
�MNnun�t bCatlwnieJHEoN the printery area AND - ...• _' -
Witnessed BY
CwrcnenI,
.. - , . .
�r._.i _-_-
Address or Lot It 444,-A
Location
e: Hole Number
Date
IL FEL LSW.S Time Weather WGr
Location(identify on site plan)
Sid
Molina
Land use
_
I SIOPe(%]J I Surface Stones
Vegetation
Landfelm
Position on landscape(sketch on the back)
Distances from:
Para MWM
Open Water Body
feet
Drinking Water Well
feet
Property Line _
feel
Possible Wet Area
feet
Drainage Way
feet
Other
feet
Deep Hole C: J
Decthian
Sulam(Inches)
DEEP-OBSERVATION HOLE LOG'
'WSW OF TWO ROLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Sat Horizon
Sal TSa
(USDA)
Sol CS
(Moo )
Odo
(SbeAae.Sines.BcSSei .CansbMCy %Gmi4
Parent Mafia(ambac) I
Death beioundxeler Slaking Water b the
Estimated Seasaul High Grand Water
DEEP OBSERVATION HOLE LOG'
Deep Hole#: eMWIIUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
DSian
Sabace(S)
Sd Keeton
Sd Texture
(USDA)
Sol Cab(
(Seel)
Sid
Molina
Other
(Sena Stars.Boulders.Consistency.%Gravel)
Para MWM
mid I
,.
'.. . .,
I Deg*WOM'Odt I�RFace
Dept bpaatlwbr: Stamina WS b be Hale
I Weepiw
I
Esbube Seamed IS Gmad Water 4
- -
Deep Hole C: J
Decthian
Sulam(Inches)
DEEP-OBSERVATION HOLE LOG'
'WSW OF TWO ROLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Sat Horizon
Sal TSa
(USDA)
Sol CS
(Moo )
Odo
(SbeAae.Sines.BcSSei .CansbMCy %Gmi4
Parent Mafia(ambac) I
Death beioundxeler Slaking Water b the
Estimated Seasaul High Grand Water
.� ......,,�. tuxmu PERCOLATION Sgy
s....�.v. <:..._..
4 '" iota"^^Add, sr of Lot No:
''.""'_""._."..= _.COMMONWEALTROF MASSAagorgfti
Massachusetts
i q
.
st: s
rimo,l lz ®-
r,LS
Tome 19-41
WcaLatN^tat mu [b
. sa. bN Yia'pidsery.anr:AND •_..
.. Su P,usd Sita FWd ❑ ...
.. ..._ Performed Bt:
4Ydm,sed By:
eomdem,:
It
Deep Hole E:
DEEP OBSERVATION HOLE LOG*
.11WWUY OF TWO HOLES REWIRED AT EVERY PROPOSED DISPOSAL AREA
poPPI kon
Surface(4d )
O c�
Sol Han
t\
k
Sol Talmo
(USDA)
Sol coot.
(Mouse")
Sol
way
Diner
(Sbwae.Sbnes.Raiders.OaWslawy,%Gavel)
II t
Pate*MOW 1peobgk) I
Oatls
Intoralwatc Sc Randr Wake In to Hob
I DepFbBetlelk %wiglomf Face
Womb]Seasonal High Gland Wake -.
Deep Hole#:
Depth kom
Surface Clothes)
DEEP OBSERVATION HOLE LOG'
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Halton
Sol Tube _. &ID:1w
(USDA) (IMmsel)
Sol
(Sbflse.Sbrcs.BaMas.OOto6bmy,%Omcel)
Location.Address or Lot#
��r
.^ - , ,,. a ,..�,
Deep Hole Number
Date
.,
r Time r t) Weather ,. —
Location(identify on site plan)
Land Use
-... I Slope(%LLa- Surface Stones i --wit-y‘..4„,
Vegetation
'.
Landform
Position on landscape(sketch on the back)
Distances from:
Open Water Body
f 1
L
E feet
Drinking Water Well
feet
Property line
feel
Possible Wet Area
feet
Drainage Way
feet
Other
feet
Deep Hole E:
DEEP OBSERVATION HOLE LOG*
.11WWUY OF TWO HOLES REWIRED AT EVERY PROPOSED DISPOSAL AREA
poPPI kon
Surface(4d )
O c�
Sol Han
t\
k
Sol Talmo
(USDA)
Sol coot.
(Mouse")
Sol
way
Diner
(Sbwae.Sbnes.Raiders.OaWslawy,%Gavel)
II t
Pate*MOW 1peobgk) I
Oatls
Intoralwatc Sc Randr Wake In to Hob
I DepFbBetlelk %wiglomf Face
Womb]Seasonal High Gland Wake -.
Deep Hole#:
Depth kom
Surface Clothes)
DEEP OBSERVATION HOLE LOG'
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Halton
Sol Tube _. &ID:1w
(USDA) (IMmsel)
Sol
(Sbflse.Sbrcs.BaMas.OOto6bmy,%Omcel)
COMMONWEALTH OF MASSACHUSETTS.
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5.'
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:
Owner's Name:
Owner's Address:
Date of Inspection:
Nerve of Inspector:(please tint) 1t/!/ 67. #i n, .Pe
Company Name: ,S/ itcs --/4 ,-/u
Mailing Address: .. i /20.41
Telephone Number: £ /f4o. /14fl s
AICIAti71 4241 ,-4041-4
oti 149:575. eve 6, a
/izaAd
CERTIFICATION STATE ENT 1 ��a�
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is nue,accurate and complete as of the time of the inspection.The inspection was performed batsed co my
training and experience in the proper funWOn and maintenance of on site s - . t.F systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(31 ;.�"
Mk As
Passes.
Conditionally Passes EMI^
Needs urtherEV , atio1 . b
Fair
s.
Inspector's Signature:
The system inspector shall submit copy of this impaction report to the Approving Authority(Board of Sean!:or
DEP)within 30 days otcompteting this itupeedon.If the system.Si shared system or has a design flow of 10,000
gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,If applicable,and the approving
authority. '
N �� 1T / /� a � /f¢s /otes and Co Comeats y .X St yo7,e ,c/�z /E1fv J C2/6„,,e_ /A)
t
c/ 71 '4,
'*'*This re ort onl OSe,d es/e...
/c
P y describes conditions at the time of inspection and under the conditions of use at that
time:This Inspection does not address how the system will perform In the(nun under the same different
conditions of use;
Page 2 of l 1.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oortrrdi
Property Address:
Owner.
Date of lospeetion:
°tJ /u ass
S/aY/o5-
Inspection Summary: Check A,B.C,D or /&&.WAYS complete all of Section D
A. System Pasty:
i( I have not found any information which indicates that any of the Mum criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
(�//-C ono ioX 0,0 /iGT GLec/ I07Z
CommeabI
B. System Condltlondly Pores:
,_ One amore system components as described la die"Conditional Pass"section need to be replaced or
,4epeired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the_for the following sta•emea•• If'bot determined"phrase
explain.
The septic tank is metal and ova 20 years old*or the septic tank(whether metal or not)Is structurally,
astound,
exhibits substantial Infiltration or enfihadon or tank faihn b kmoioeot.System will pan impecdon If the
existing tank is replaced with a complying septic tank as approved by the Board of Heat
eA metal septic ma will pass inspection if it is structurally sound,not leaking and ifa Certificate of Compliance
indicating that the tank is less than 20 years old is availbk.
ND explain:
Observation of sewage backup or break on etatlo water lewd in the dierbution box due tot:oken or
obstructed pipe(s)or due to a broken,settled or tureen distribution box.System will pan Inspection If(with
approval of Board of Health):
broken obsweHelaremosed •
distribution box le tented or emplaced
ND explain:
p� If mar required�pumping more Pogo 4 times a year doe to broken or obstructed pipe(s).The system will
approval of the Board of Health)
broken pipes)are replaced
_obstruction is removed
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
�/ CERTIFICATION(continued)
Property Address: c5' ,c'onn,' 1"11-17/5 Fo.-W
,t7 2e.2 O /t1/t/1.4-.SS
Owner: T t G�CxI"
Date of Inspection: .d--/dy/US
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(6)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning io.a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: eV /U LM,E 4,eM,5° /Zo/l�✓
/(10.477/.41/27/2/r4J /W MS
p, rti ceo
ts7,Sift s
Owner:
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
x
—
NA
X
-g�-4
p
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than''day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of asurface water supply or tributary to a surface
water supply,
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes If the well water analysis,
performed at a DEP certified laboratory,for conform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
N0 (Yes/No)The system fails.I have determined that one or more of the above-failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems: ,40r4/4
To be considered a large system the system must serve•a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or`no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone U of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
'ryes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
Page5 of11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
8s' N64 n' t45- %ZFJnD
cGczy Ai WAVY
Property Address;
Owner:
Date of Inspection:
d/av/or
Check if the following have been done.You must indicate'yes"or"no"as to each of the following:
Yes No
y Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
)Y _ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
Y _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
au
_ Was the site inspected for signs of break out?
.N0' _ Were all system components,excluding the SAS,located on site?
x _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on
Yes no
A' _ Existing information.For example,a plan at the Board of Health. o w-ti /-//PflcJ O?J y /ti,
C/ 15
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/��J 7 SYSTEM INFORMATION
Property Address: e /i/O,Z)W A/7j2/211 CAW
420anyg )PTO a/ ^ /X)
Owner: P. /t 1 r �G 7
Date of Inspection Y/oi5/0S-
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): s.._
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): I/O Y3 0 3'0
Number of current residents:
Does residence have a garbage grinder(yes or no): /10
Is laundry on a separate sewage system(yes or no)4,/p) [if yes separate inspection required)
Laundry system inspected(yes or no):_
Seasonal use:(yes or no): 44)0
Water meter readings,if ava lable(last 2 years usage(gpd)): a,6%L-t
Sump pump(yes or no):sit/ea CCU-'t r
Last date of occupancy: - yt
COMMERCIAL/INDUSTRIAL 0/V/�
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: daf�(A
Was system pumped as part of the inspection(yes or no):1,2-4I
If yes,volume pumped:JdVOgallons-How was quannty pumped determined? /1210,0111-CGS
Reason for pumping: /OOU /
/NSte-Cker / OR- /AWE- -
21"E OF SYSTEM
� Septic tank,pdstribution box,soil absorption system „32 fine_Y� lej
Single cesspool
_Overflow cesspool / LBni.GA" fr/44D
envy / /0Om,p c,%Jn-in •fey
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all c mponents,date installed(if known)and source of information:
$1 TOTS al✓ /"
Were sewage odors detected when arriving at the site(yes or no): /v0
Page 7 of I1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ SYSTEM INFORMATION(continued)
/
Property Address: 6 /VJ i ,207t2)
Owner: / Mc COy
Date of Inspection:
BUILDING SEWER(locate on site plan)
Depth below grade: �
3G 1/Materials of construction: cast iron ✓es PVC other(explain): cSO2„t6'
Distance from private water supply well or suction line:
Comments(on condition ofjoints,venting,evidence ofleaka_ ,e .):
SEPTIC TANK:_(locate on site plan)
/,
Depth below grade: /9
Material of construction: ✓concrete_metal fiberglass_polyethylene
_other(explain).
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) ,,,,zo(o. i' d/
Dimensions: /F✓/L/ /D 1p E5 'f ' 8G 4.6— 5 '
Sludge depth: - ,3 u
Distance from top of sludge to bottom of outlet tee or baffle: c7%
Scum thickness: /
Distance from top of scum to top of outlet tee or baffle: • 3„
Distance from bottom of scum to bottom of outlet tee or baffle: /j
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evident o .leaks e,etc.):
,r est. Ot'F r fi44t c/- ot)
%'d GWJe c 1
GREASE TRAP: (locate on site plan)
Depth below grade:
Material of construct ion:_concrete_metal fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
,1 SYSTEM INFORMATION(continued)
Property Address: /�'� i�/ntni,s ,&'
le 4i "11. 7
Owner: A G y
Date of Inspection: trA✓SC/05--
TIGHT HOING TANK:_(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal_fiberglass polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):_
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: C)
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
/Un9, 3954A, Stir 4-1 91-741-#
CO6yc/r 170
4 )
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
S
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: C> % /C1072/741, g12.44y /2-014t/
nnrfm,0770W MP55
Owner: rWle. Coyer/�
Date of Inspection:__a War
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_leaching pits,number:
_leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
X innovative/altemative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): AirfGT/ZJ7-ro/L 4/41/ 7). ' A/o ,7o4Acin5' Nornd)
tWA
CESSPOOLS:_(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY:_(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
�A), A445.1-Owner: . /V C Co 4
Date of Inspection: /
5-4v/cam
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks for
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
New tSOO 6//K
sevnc
10
Page I1 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYM11'f 1, TIME (c/ O r�
Property Address: B9 /L'Ot)1V `7WA)V.c /f ✓
Owner: fr, "Ic Co N
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water T feet
Please indicate(check)all methods used to determine the high ground water elevation:
obtained from system design plans on record-If checked,date of design plan reviewed:
bserved site(abutting property/observation hole within 150 feet of SAS)
hecked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Ece Oil«ji A./Ate 5WPl7G .0-157 91c/ 7C 6r/
—CONCRETE SLAB FOUNDATION
4' PVC PIPE (SOlid) (3 .02)
CL FI
PROFILE (nt
ar _
STING SEWER LINE
INVERT ELEVATIONS
INV OUT WALL I EXIST/NG 92.90(assumed)
/NV IN PROPOSED TANII 1 92.30
rim OUT TANS 1 92.33
INV IN PUMP CHAMBER 1 91.19
2' FOR
3
D' BOX 1 98.02
114V IN INFILTRATORS 1 97.50
BOTTOM OF STONE 1 96.00
ESTIMATED SEASONAL HIGH WATER 1 92.00
PERC TEST DATA
BEGIN SOAR; 9:45 AM
END SOAE: 10:00 AM
12' 10:00 AM
9' 10:06 AM
I IO 16
PERC RATE ■ 4 MPI I 80'
O-B A
STANDING
NREPING:B
ESHWT 60, sauNL1$$j.
ALL
AND *ZIS 117,L"TO BE REM
wrz
���fl OLEAN Pfll
ItDING`"IU1TE
ca = '
21..3'h)6, SIDES a 324 SQ.
,..
X 1.S'h)6 ENDS a 27 SQ. FT.
'1 x 3'w)3 BOTTOMS a 324 SQ.
6 gals + 19.98 gallons + 239
GPD/SQ PT
.3'h )
. x 0.74 a 239.76 GALS
x 0.74 = 19.98 GALS
PT. x 0.74 a 239.76 GALS
.76 gallons a 499.50 gals
DAILY FLOW - 495 GPD
DESIGN FLOW a 499.50 GPD
= 20 ' )
EXISTING PON
BAL VSILT FENCE
e
Y WASTE (see es)
PROPOSED 1000-
PLAN OF
=SURFACE SEWAGE
!OSAL SYSTEM
MI FARMS ROAD
'HAMPTON, MA.
VC PIPE (sj
ORS
CR5
PERTY OF PATRICK McCOY
)F WETLAND(see notes)
PROPOSED DISTRIBUT
75 '
HAY BALES/SILT FENCE
OE=BV£FE12 -ZONE
°�
4• PVC APE (so
_ PRO Fltrti ES :(set note§j..
TO BE EX
Relay in Weather Proof Manhole Cover
Enclosure -��Q
y7 Vent
1 I . I A I1 ,y
•
• S Hanger Pem
- ' r for Philip Roomy.) ,
7 High Water Chuck Dr..rno him t
Alarm Switch Siting Cenpler
Reserve Capacity
Alter Alarm Sounds _-��Elllucm
�_
Stan Level - - -
Level Control Switch/
Shut-ON Levels 1 _
/I W
Control -T I. ILL v
Switch 01]I]
CRUSHED'STONE
•
i 6° or
:MD.
!AIR „n, • PUMP SPECIFICATIONS:
t TO WITHIN GOULDS - MODEL 1 3886 (OR EQUAL)
flair
ID AVOID
TOTAL DYNAMIC READ = 12 ' ±
ALPSS PAC
ELECTRICAL
IODISED
FLOAT I 1 - POMP OFF E 4" ,
ID SIll OT FLOAT I 2 - PUMP . ON 2 12'
AceoRDAEe FLOAT t 3 - ALARM ON B 16' •
Mean PIMP
1/6' - 1/2' WASHED STONE
(2' COVER)•
BD STONE --4--.
' , -- ' G. -4 •1 I l r 12 r'(n w)
•• tea_
• '
• •
a.
ATIATOR SITE NATIVE SOIL. • I ��••. .
vEE SOPPENT m SIENS• •: . ••••••• . . .. . •EIDE AND SITTING FOR E•10 ? • ...•
I IS COMPACTED AND SRTLED •. • • e
L SOPPOT VESICLE TEIGST .. w
II TM S-10 WITS. • • • •a U
•
. [ 31a a •BE INSTALLED =MOCKER D O • • • •
MI
ROSINED OQ0Il0W0. LID OF •• • •a . . . .. s • a a •
I
PDS OF INYIITRATOR. • • . • s • • • a •
• • •
w nLT INVERTS. • • • .a . as .a o •
• .
1 11
H-20 WHEEL LOAD
CONTRACTOR NOTES
•
�.fl��Jr�.•_I TIM YILTa. -5SRLL'NOT =Inn
Q:'LEw ml 2 IS7aES" fauns Alta ;s•stuG.
{IVE'SEALL ffi YE!lORIRD ffi.. ..
m TO 4S9 sT REINS w SEE TILL
L.II TEE I 4 SEIVE. TL AL arm
Ta=
c22 SAND OR argot cram Gtwm. R rest, COSMIC sartneXiame =Mai,
rats,
ID OM. now COMM CT TARTE*MOOD. TREE
AID STATE CwS!RUCTIw D®RIS. _ .
U& .STUD.L To EE maim ma EEYLaen 'ENE C •'w Dial nCfOFClYOII ill^y'
IIIi. To E23VATIw 91.00
SIMS API AYPROIIEATI Am.NOS TEE RESULT OF A MID - : .• eWIr..4.W.
NOT POE CwVESRTl3 • - - amm..b`tiM1e4.It ssantiNtssnl rr" ..a
0 FACILITY MET TEE Nis In l.aepm INW opal.
TS OF TEE STATE SANITARY CO ON TITLE V. Wean F In awla'al lw'Anlum who unulewrt
Notts m lan[a Wasaafl gsloelMTekt
OD CTallG0IATIa OF 900n IS ss I FOR REYF1m.CE In mmfa�' mw laws In Man.lmaa It.
.nluNax�nAbiinpnlalame6A{e.atnll uIck
DIAL SITE MAT VART. luwalry.+lln �.n�Iuwnbwta.lndugWc
EC/ IN DONL Ill ACCORDANCE SITE TEN STAIN SANITARY p�a.4vuN WabieWQlwsuicoaaYaa)l
- slut)
Mc MN emlmnks Mw An1aIM1 IN
IS SERVED BY MOAICIPAL WATER SUPPLY OF WCR2'EAY.P1T111. menthes. D e all se N •IN Es ft llo
I SHOWN TON REYERLICE OILS. ALIQAL POINT OF ENTRY ..ill es.Due call se Ills•OilC Taft line
Inkein
le main IN Ilut. InW ab
the
I-TARY CODE In M»Mmmas. at jumbo Y I sac
W THIS 6THE misicannlED TO.T'EE STATE ffiTEE 'APPROVAL, In /lallir. 'kw Ilan. i1W, Unman' NA
TENORS THE OF TIIS S STNNOt II DESIGN W. k WaW.OSnumbest.l NO 113-077.'ION OR OM OT TRIO STEE S. TEE DESIGNER l WARRANTS. Ifdmrtammaaea.alballlbla Ti a.
AGAINST ED IS I OF TEE SYSTLI. Owanl amlunf will Wnulf/Nwrkalln
OR IMPLIED. IS MADE• Er pm.MU will eliminate On l..IWJW/W
aanunc NU a.<pw sic amount non,IS DESIGNED FOR A GARIN= DISPOSAL As PER Ie/wla
1'w BOARD ET BRAISE REGOLITIONS. HOWEVER, A GARBAGE &act Ow askdWc.nl BWLcAR)NsWO
IS NOT IN WAXED. . DIG SAFE
PLIL TO TO PR ,NI SOIL F FROM SEEDED OUT. ATLLY
Pf.ETIw TO PREVENT SOIL nlON IDL5SI116 OUT.
ION PLAN SHALL Eat EE USED tat A DETTERMINRTION OF
ILITT TO TEE CLMVS PROTECTION ACT.
TOLERANCES
REVISIONS FOR: PATRICK McCOY ..
l..a........•I mow can NT 84 NORTH PARKS ROAD - NORTNAHPTON.r. MA
ORCIMAL I BY: TIMOTHY E. -MAGINNIS RS
70 MONTAGUE ROAD, WESTHAMPTON, MA
[
FRACTIONAL DRAWN Er SCALE IAI.
•
E` I TEM AS NOTED
± CHWO OAT[ -/y/� OPAWING NO. •
AWCULAM • G-Ln " "
asR.S. ,_, ,.,,_a. c .,v _.
ral
EEIEEEA EEEE,EE�,1 1 1EEEE1�1n1 i�ii�i�i�i�i®i®i®ia i t:::>s-$$
■11�111T�i IM�I :1�I -`ll 111i i1=■ii. l li =i®I®®'®ii
AI E i.7141liP �zN----":6
(?
6.25
H-20 WHEEL LOAD
92.00
CONTRACTOR NOTES
arts:INO Barrie:rNE To at ammo AND•HEIpVPI
ALL saaxnnar-oNTEE TO'EE'DISPOSED"OF'tw 'ACCT
STATE•SIIAITANT`41001111Tf21*/F r✓. :e: •. ^.,:.
WD r"t OPIrm C'1•RAN QRANOLAR MATERIAL YNe
sax srma'DxsaassatTl7.afne'MEBY fabaT'Im..'TL
TO PROPOSED 1000 CALLOW SEPTIC TANS. '
EXISTING SOIL AEBORSTICW SYSTEM TO HE DISCCN
REMAIN IN PLACE WITH APPROVAL Or EQ rasa= a
HEALTH. • • . .
PROPOSED. SEPTIC TANIS, 'POMP CHAMBER, AND DIE
BE INSTALLED LEVEL AND TRUE TO GRADE CM A sr
ass.no 1ctatazatLT cawA® AND on
LIKPaEra-
H
r v
sy �ao.et..:isd��_ fff
Mt" 1,..ard •f Health
o the followins conditions:
\ Design Engineer must inspect
and verify in writing that
he sewage disposal aystem
vas installed in accordance
'"i thez'e approved plans.
SAND
YR 4/3
0 - a.
S' - 54'
■
54" - 120'
G -WATER7 _
60"
60'
r l LEFT T OPEN. TO PROVIDE VENTILATWIT
COMPARTMENT CCTSECTIDD To EE EQUIPPED WITH <
PIPES. SEPTIC TNI MD DISTRIBUTION BOX TO I
PVC.
TEES SHALL EXTEND A MINIMUM Or 6 INCHES ADO
ND 10 AND 14 INCHES•BELOW THE FLOW LINE BE.
TIME SHALL BE AN AIR SPACE Or AT LEAST 3 D
TOPS or TEES AND INSIDE OF TAE COVER. THE
ELEVATION SHALL QE MO LESS THAN 2 =CANS NO
INCHES ABOVE THE:ELEVATI® OF THE OUTLET PI
SEPTIC•TNE SHOULD HE INSPECTED AND CLEANED
THEM TEARS. .•
DISTRISOTICN BOX CUTLET PIPES TO BE LAID LI
TWO FEET.
ANNA TO N EXCAVATED. THIS strum ;s DESIGN
THEREFORE, ALL TOPSOIL, SUBSOIL, AND OTHER
MATERIALS SHALL BE REMOVED FROM ALL AREAS E
LEACHING PACILITT AMD FOR A DISTANCE Or 5 E
DIRECTIONS.
_ EXCAVATED AREA TO HE FILLED WITH CLEAN FILL
I SOIL ASSO
SEE NOTES)
TION SYSTEM
SHED
GARAGE
EXISTING`SEWER LIN
91i4: S= .02).
PUMP cuitte„Th
00 '
ION BOX
(3:.
PIP;
THE COMMONWEALTH OF MASSACHUSETTS
4OR7%I irprOA MASSACHUSETTS
ation for !ispuzui *stem Tonstructiun Permit
Ft
�t.
by made for a Permit to Construct
Repai (v) an On-site Sewage Dispo.al System at:
location Address,or Lot )No.
a* N FaRm
n/�
RPr
Name Address Tel o.�
�g l Sa/'v
6 -84/
N Addr le N
Designer's Name,Address and Tel No.
MA
r
SL7�J Z9/
Installer me. and
a
(�
Type of Building:
Dwelling
Other
Design Flow
Plan Date
Title
Description o
No. of Bedrooms 5 6,4r-(. )
Type of Building cAf� No per Persons 6 Showers( ) Cafeteria( )
Other Fixtures
/ t• 50 gallons per day. Calculated daily flow 469.0 gallons
"-6__L'g9 Number of sheets / Revision Date
fs'& op Ptacosac) 5 ASuRFACA SF-w - �t POSQ C 16174 �
Oa S L . 3 2 ( 5 o /°#i/s
j, tr /'n2
Nature of Repairs or Alterations Answer when applicable) Ecifira- SU ECRU Drat ii 3. )P
Daspoz•wL SysTr.N
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Complia e has •een issued by this Board of Health.
igned � 11 e 1 U Date
Application Approved by
Date
Application Disapproved for the following reasons
Permit No
Date Issued
THE COMM• WEALT¢I OF MASSACHUSETTS
L. ' - fi MASSACHUSETTS
an <.
QIertific to of Compliance
THIS IS TO CERTIFY that the/On-site Saw.: Disposal System installed, ,lor repair d r place °O
�/fleIf / by t- 1C-i .c C_ for i l 9,( Ph /Pt( LBt-/
at . ' / has been c strutted in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No /`1 9 dated
Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall,not be onstrued as a guarantee that the syster will function as desig d. This
Certificate expires on
DATE
O▪• N
8 5 1 .-1 , r
O.w .ri .. $�j
E t.2, roi N YRrmission is hereb•granted to i / z
ra c
L �Co it Sewage le' ;( r
.eons[ruc[( ) or epmr )a On-site Sewage System located at
✓ v m . / i
c .Mn es
N � d
' 4y described in the above Application for Disposal System Construction Permit. The applicant recognizes his,h
LO D1 comply with Title 5 and the following local provisions or special conditions.
Eb n . all o1lstructiep must be completed within three years of the date below.•
8 i3 55§rt \jL' f �,- / l/� Approved by
FORM 12 Rev.] A.M SULK IN CO.-BOSTON.MA
V
Spector
THE C• MONWEALTH OF MASSACHUSETTS
MASSACHUSETTS FEE
pispnsttl a stem Construction Permit